Background: CDC guidelines for EOS evaluation based on maternal risk factors are not clear and leads to increased laboratory workup and initiation of antibiotics. Increased antibiotics use leads to separation of mother and the baby, decreases breast feeding rates, increases antibiotic resistance and ultimately increases health care costs. Neonatal sepsis calculator published by Kaiser Permanente group based on a large multicenter study is being used at several Neonatal Intensive Care Units (NICU) nationwide. This freely available online tool can be used in assessment of EOS in newborn based on maternal and neonatal risk factors. This calculator has been proven to decrease the antibiotic use for EOS in several NICU's. Objectives: To decrease the antibiotics use to < 7% of live births for EOS at Truman Medical Center by implementing the sepsis calculator use guidelines for newborns >34 weeks gestation Methods: Our quality improvement project was designed by using smart aim, process, outcome and balance measures and a PDSA cycle format. A retrospective chart review of 87 charts over 4 months period was conducted by a team of newborn providers. Maternal data collection included maternal antepartum highest temperature, rupture of membranes, GBS status, antepartum antibiotics use etc. Neonatal data included heart rate, respiratory rate, respiratory support including oxygen requirement etc. We determined the rate of antibiotics use at newborn unit before the calculator implementation. Once this data was obtained, we implemented the sepsis calculator for use in >34 weeks newborns with suspected sepsis in first 24 hours of life. Multiple sessions were conducted to familiarize the sepsis calculator to Pediatric residents, Pediatricians, NNPs and PNPs. Written guidelines were circulated to guide the use of sepsis calculator. We obtained the data on antibiotic use by reviewing 85 charts over a 4 month period after the sepsis calculator implementation and compared with the data prior to calculator use. Results: Antibiotics use was 11% prior to sepsis calculator implementation and was above the national average. Antibiotics use decreased from 11% to 5% with the sepsis calculator use (figure 2). Provider’s comfort was significantly improved to utilize the objective data rather than subjective data in evaluating EOS. Sepsis calculator use was >90%. Admissions to the NICU and antibiotics to infants born with maternal chorioamnionitis were decreased. None of the blood cultures were positive on neonates without antibiotic use. Conclusions: Neonatal sepsis calculator is a great tool in optimizing the antibiotics use for >34 weeks newborns at newborn units and should be used by providers taking care of newborns in first 24 hours of life. Future goal is to implement using the sepsis calculator at nurseries covered by Children’s Mercy in Kansas City Metro and keep ongoing goal of < 6% antibiotic use.

Antibiotics use before and after sepsis calculator implementation

Antibiotics use before and after sepsis calculator implementation

Monthly antibiotic use before and after sepsis calculator implementation

Monthly antibiotic use before and after sepsis calculator implementation